Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0623 | AZ |
NPI | 1164524138 |
---|---|
Provider Name | Dr. Jeffrey Clarke Page |
First Address | Glendale, AZ 85308-6813 |
Second Address | Glendale, AZ 85308-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 22/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
364313 | (05) | AZ |